Tibial plateau leveling osteotomy plate

ABSTRACT

A TPLO plate configured to accommodate flexible strands (flexible loops) attached to tissue to be attached to bone. The TPLO plate has one or more suture eyelets, to allow the user (surgeon) to pass a flexible strand through the eyelets and attach/reattach the tissue to the plate at the anatomical location, and to improve the rotational stability of the joint or bone. The eyelets may have various shapes, forms and configurations and may be provided on or within a surface of the TPLO bone plate in any number, depending on the characteristics of the fractured bone or bone segments, or of the plate design. The eyelets preferably receive one or more flexible strands.

CROSS-REFERENCE TO RELATED APPLICATIONS

This is a continuation of U.S. patent application Ser. No. 17/348,899,filed on Jun. 16, 2021, which is a continuation of U.S. patentapplication Ser. No. 16/420,602, filed on May 23, 2019 (now U.S. Pat.No. 11,096,729), which is a continuation of U.S. patent application Ser.No. 14/533,768, filed on Nov. 5, 2014 (now U.S. Pat. No. 10,299,841),which claims the benefit of U.S. Provisional Application No. 61/900,123,filed on Nov. 5, 2013, the entire disclosures of which are incorporatedherein by reference.

FIELD OF THE INVENTION

The present invention relates to methods and apparatus for surgicalprocedures.

BACKGROUND OF THE INVENTION

Tibial plateau leveling osteotomy (TPLO) procedures are well known inthe veterinary art. Tibial plateau leveling osteotomy procedures areused to correct ruptured cranial cruciate ligaments for various animals,particularly canines. These procedures provide an alternative therapy toligament repair procedures. Tibial plateau leveling osteotomy procedureshave become the standard of care for medium and large canines.

When the canine ligament partially or fully ruptures, the tibial plateauleveling osteotomy procedure provides a way to correct this problem. Acurvilinear cut is made to the upper portion of the tibia. This cutportion of the tibia is then rotated on the order of about 20-30 degreesto create a more level plane or surface on the top of the tibia uponwhich the femur can rest. The cut and repositioned portion of the tibiais then secured to the lower portion of the tibia.

There is a need for a TPLO bone plate provided with a new design thatallows surgeons to secure to one or more tibial segments of an animal,as part of a tibial leveling osteotomy procedure for an animal. Alsoneeded is a TPLO bone plate that offers a means for providing rotationalstability, particularly means for providing additional rotationalstability to the TPLO procedure. Also needed is a method of fracture orosteotomy repair in animals that allows securing of dissected softtissue to the anatomic position where it was dissected, during thefracture or osteotomy repair.

BRIEF SUMMARY OF THE INVENTION

The present invention provides apparatus and methods for bone-tissuefixation (for example, bone-soft tissue fixation) in animals,particularly canines, using a TPLO plate having one or more sutureeyelets/holes/slots provided within the body of the plate to allow theuser (surgeon) to confer means for providing rotational stability to thejoint or the bone, and to the final TPLO repair. The TPLO plate may bealso employed, if necessary, to reattach tissue (bone or soft tissue,for example) to the plate at the anatomical location where the tissuewas dissected. The suture eyelets/holes/slots may be provided in anynumber and at any location on the plate, for example, on the proximalregion of the plate.

The TPLO plate of the present invention includes a body preferablyformed of a metal and one or more suture eyelets (suture holes or slots)or other similar features which are incorporated into the shaft (forexample, the proximal region) of the plate. The suture eyelets (holes)may have various shapes, forms and configurations and may be provided onor within a surface of the bone plate in any number, depending on thecharacteristics of the osteotomy or of the plate design. The sutureeyelets preferably receive a flexible strand for fixation of tissue(bone or soft tissue) to the bone plate to improve the rotationalstability of the bone or joint.

The present invention also provides a method of improving the rotationalstability of a joint or bone, for example, of the knee or stifle duringa TPLO procedure. The method comprises the steps of: (i) providing aTPLO plate that includes one or more suture eyelets/holes/openings/slotson or within the bone plate; (ii) fixating the TPLO plate to bone withfasteners such as screws; (iii) passing suture through one or moresuture eyelets of the TPLO plate; and (iv) securing the suture to boneto improve the rotational stability of the bone/joint and the overallTPLO repair.

These and other features and advantages of the invention will be moreapparent from the following detailed description that is provided inconnection with the accompanying drawings and illustrated exemplaryembodiments of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1-3 illustrate schematic subsequent method steps of a TPLOprocedure with an exemplary TPLO bone plate of the present invention.

FIGS. 4-6 illustrate various X-ray views of a TPLO plate of the priorart positioned on canine tibia.

FIGS. 7-9 illustrate various X-ray views of a TPLO plate of the presentinvention (superimposed on the TPLO plate of FIGS. 4-6) to illustratethe differences between the TPLO plate of the present invention and theprior art TPLO plate.

FIGS. 10(a)-(d) illustrate various views of an exemplary 2.7 mm standardTPLO plate of the present invention.

FIGS. 11(a)-(d) illustrate various views of an exemplary 3.5 mm smallTPLO plate of the present invention.

FIGS. 12(a)-(d) illustrate various views of an exemplary 3.5 mm standardTPLO plate of the present invention.

FIGS. 13(a)-(d) illustrate various views of an exemplary 3.5 mm broadTPLO plate of the present invention.

FIGS. 14(a)-(d) illustrate various views of an exemplary 4.5 mm standardTPLO plate of the present invention.

FIGS. 15-32 illustrate subsequent steps of an exemplary method of TPLObone plate fixation according to an embodiment of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

The present invention provides TPLO bone plates having one or moresuture eyelets on or within the plate, to allow the user (surgeon) toincrease the rotational stability of the bone or joint and, optionally,to reattach the soft tissue to the plate at the anatomical locationwhere the tissue was dissected.

The TPLO bone plates of the present invention are provided in varioussizes, for example, 2.7 mm standard, 3.5 mm small, 3.5 mm standard, 3.5mm broad, 4.5 mm standard, etc., accommodating correspondingly-sizedscrews. The TPLO bone plates are designed to accept various locking andnon-locking low profile cortical screws. In an exemplary embodiment,each plate is provided with a suture hole located cranially on theproximal portion of the plate that accepts one flexible strand, forexample a strand of #5 FiberWire® or FiberTape®. Each plate is providedwith a surface cut demonstrating where a laser line for the osteotomywill be. All angles and radii for the proximal contour may be equal foreach plate design. Some geometries between the 2.7 mm, 3.5 mm, 4.5 mmplates are slightly different.

The TPLO plates of the present invention may be provided as singledevices and/or as part of kits incorporating additional instruments anddevices. For example, the TPLO plates may be provided with additionalcomponents known for TPLO procedures, such as locking and non-lockingscrews, threaded drill guide, drill guide, graduated drill bit,screwdriver such as hexalobe screwdriver, QuickConnect driver such ashexalobe QuickConnect driver, all sized according to the particulardimensions of the TPLO plate to be employed with.

The present invention also provides a TPLO procedure that improves therotational stability of the joint or bone. The method comprises thesteps of: (i) providing a TPLO plate that includes one or more sutureeyelets/holes/openings/slots/apertures on or within the bone plate; (ii)fixating the TPLO plate to bone with fasteners such as screws; (iii)passing suture through one or more suture eyelets of the TPLO plate; and(iv) tying the suture to bone to improve the rotational stability of thejoint or bone.

An exemplary method of fixation of anatomical tissue during surgicalapplications by employing a TPLO plate that improves the rotationalstability of the bone or joint or repair site (surgical site), and alsoallows reattachment of soft tissue to bone and to the plate, comprisesthe steps of: (i) providing a TPLO plate that includes one or moresuture eyelets/holes/openings/slots/apertures on or within the boneplate; (ii) placing the TPLO plate on the bone and dissecting theadjacent soft tissue to allow the plate to fit; (iii) fixating the TPLOplate to bone with fasteners such as screws; (iv) passing suture aroundthe bone and through the suture eyelets of the TPLO plate; (v) passingsuture through the dissected soft tissue and through the suture eyeletsof the TPLO plate; and (vi) tying the suture to improve the rotationalstability of the bone/joint/repair site, and to secure the dissectedsoft tissue to the anatomical position/location where it was dissected.

Referring now to the drawings, where like elements are designated bylike reference numerals, FIGS. 1-3 illustrate a TPLO plate 100 of thepresent invention provided with a plurality of suture eyelets 99(openings/slots/holes/apertures 99) incorporated into the plate to allowsoft tissue attachment to the plate. For exemplary purposes only, theTPLO plate 100 is illustrated and described below as a bone plate forproviding improved rotational stability in osteotomies of an animal suchas a canine, and attachment of dissected biceps and/or adjacent muscles.However, the invention has applicability to the fixation of other bonesor bone segments of canines or of other animals, including the fixationof associated soft tissue to bones or bone segments.

As shown in FIG. 2, the TPLO plate 100 includes a rigid body 10 with alongitudinal axis 11, a transversal axis 13, a first surface 17 and asecond bone-contacting surface 19. Body 10 is preferably formed of ametal such as titanium, titanium alloy, stainless steel, or othermaterials that possess mechanical and physical properties suitable forcoupling bones together. Body 10 is also defined by a distal region 12(shaft 12) surrounded by a distal edge 12 a and a proximal region 14surrounded by a proximal edge 14 a.

The body 10 of the TPLO plate 100 is provided with a first plurality ofthrough holes or openings 55 a, 55 b that receive corresponding screwsor similar fixation devices 25 to secure the bone plate to bone. Thefixation devices 25 may be screws, anchors, washers or any combinationthereof for securing the bone plate to bone. The first plurality ofopenings 55 a, 55 b extend from the first surface 17 through the body 10and to the bone-contacting surface 19, for accommodating at least onefixation device. Openings 55 a, 55 b may be provided in any number andmay have similar or different perimeters. Openings 55 a, 55 b may bealso optimally placed in the body 10 of the plate and at various angleswith respect to transversal axis 13 of the plate 100. Additional smallholes may be added within the body of the plate for the purpose ofinserting k-wires to help keep the plate stable during the process offixating the plate to the bone. Exemplary plate designs may incorporatea single suture hole with a diameter approximately double than that ofthe diameter of k-wire holes.

The first plurality of openings 55 a, 55 b includes a first set of holes55 a located within the proximal region 14 and the distal region 12 andextending asymmetrically along the longitudinal axis 11 of the body 10,and a second set of holes 55 b located only within the distal region 12and in asymmetry relative to the longitudinal axis 11 of the body 10.

At least one of the openings 55 a may include spherical bushings toallow variable angle-locking to be achieved by threading at least onetapered locking screw into the spherical bushings, as detailed below.The tapered head will expand the bushing, locking the screw to theplate. Non-locking screws may be also employed and can be placed in anyopening 55 a. If polyaxial bushings is employed, the polyaxial bushingsoffer the surgeon the freedom to direct the fixation devices (forexample, screws) within the anatomical template, based on the fracturepattern and bone quality for better fixation and to achieve a lowprofile polyaxial suture plate with any angulation, for example, a 60degree angulation. The polyaxial bushings in each hole providemulti-directional locking or non-locking capability of the plate/screwconstruct to the bone. Drill guides can angulate the bushing to thedesired screw trajectory.

Openings 55 a may be provided in any number and may have similar ordifferent perimeters. In the exemplary embodiment shown in FIG. 2,openings 55 a are circular and have the same diameter, while openings 55b are oval and have same shape and dimensions. Openings 55 a, 55 b maybe also optimally placed in the body 10 of the bone plate and at variousangles with respect to a transversal axis of the TPLO plate 100.Openings 55 a, 55 b are preferably arranged non-linearly with respect tothe longitudinal axis 11, for the 3.5 mm broad plates and 4.5 standardplates. In addition, as and shown in FIG. 2, axis 11 a passing throughboth centers of openings 55 a located on proximal region 14 and disposedalong edge 14 a is about parallel to the longitudinal axis 11 of thebody of the plate 100.

As also shown in FIGS. 1-3, the TPLO plate 100 includes a secondplurality of through holes or apertures including one or more sutureeyelets 99 (suture holes or slots) which are disposed within the body 10of the bone plate 100. Exemplary TPLO plate 100 includes one, two orthree suture eyelets or holes 99.

The suture eyelets 99 preferably receive a flexible strand 70 (FIG. 3)to increase the rotational stability of the bone or joint. The sutureeyelets may also help in the fixation of soft tissue 80 to the boneplate 100. For example, and if desired, suture eyelets 99 allow the user(surgeon) to reattach soft tissue 80 to the plate at the anatomicallocation where the tissue was dissected. The suture eyelets 99 may havevarious shapes, forms and configurations and may be provided on orwithin a surface of the bone plate 100 in any number, depending on thecharacteristics of the osteotomy or of the plate design.

Suture eyelets 99 may be recessed and they extend from the first surface17 through the body 10 and to the bone-contacting surface 19, toaccommodate at least one flexible strand attached to soft tissue to bereattached to the bone and to increase the rotational stability of thebone or joint. Although reference to the eyelets 99 will be made belowas to the suture eyelets 99, the invention is not limited to thisexemplary-only embodiment and contemplates eyelets for passing of anyflexible strand, for example, suture, suture tape such as FiberTape®,suture chain such as FiberChain®, or a flexible material forming (orpart of) a continuous loop/button construct provided with a button and acontinuous loop attached to the button, among many others.

Suture eyelets 99 may be chamfered suture eyelets or provided withfillets. Suture eyelets 99 are provided within the body of the plate 100to allow the user (surgeon) to pass one or more flexible strands (forexample, one or more suture strands such as FiberWire® suture) after orbefore the plate is fixed to bone. In this manner, suture eyelets 99allow the user (surgeon) to reattach soft tissue 80 to the plate at theanatomical location where the tissue was dissected and to also increasethe rotational stability of the bone or joint. The suture eyelets 99(holes/apertures/openings or chamfered suture eyelets 99) may havevarious shapes, forms and configurations and may be provided on orwithin a surface of the TPLO plate 100 in any number. The suture eyelets99 preferably receive at least one flexible strand 70 for fixation ofsoft tissue 80 to the TPLO plate 100. One or more flexible strands maybe passed through one suture eyelet. One flexible strand may be passedthrough one or more suture eyelets.

In an exemplary embodiment, the first plurality of openings 55 a have afirst uniform diameter “D” (FIG. 2) and the second plurality of sutureeyelets 99 have a second uniform diameter “d” (FIG. 2) which is smallerthan the first diameter “D.” The first diameter “D” is preferably atleast four times larger than the second diameter “d.”

According to another exemplary embodiment, the bone plate 100 of thepresent invention has one suture eyelet and two other small holes thatare intended for passing k-wires or similar instruments to facilitatestability of the plate prior to fixation with screws. The holes of theplate for accommodating fixation devices (screws) preferably areprovided asymmetrically relative to the longitudinal axis of the body ofthe plate. Other embodiments may also have only one oval hole or twooval holes that are centered on the longitudinal axis of the body of theplate.

The present invention also provides a suture plate kit (assembly) with abone plate 100 (suture plate 100) of the present invention and asuturing kit including at least one flexible strand attached to at leastone needle. The at least one flexible strand may be FiberWire® suturecontaining color coded suture, for example, a #2 and/or #5 FiberWire®sutures, with needles on each end, to facilitate suturing the softtissue to the bone plate after the plate is in place. The needles may beattached to the suture by any method known in the art, for example, bybeing swedged onto the suture. FIG. 3 illustrates exemplary TPLO boneplate 100 of the present invention with tissue 80 to be attached to itsproximal region 14 and with attached suture 70 to be passed through oneof the suture eyelets 99 (the cranial proximal eyelet 99) for furtherattachment of soft tissue to TPLO plate 100.

The present invention also provides a method of forming a TPLO platehaving suture holes for soft tissue attachment (or reattachment) forsurgical application and for increasing the rotational stability of thejoint or the bone. One to three suture eyelets 99 are formed within thebody of a TPLO plate to enable a surgeon to easily place the tissue 80to be attached/reattached back to the bone (for example, ligament orother soft tissue) during a TPLO procedure.

The present invention also provides a method of stabilizing a canineproximal tibia, comprising inter alia the steps of: (i) providing a TPLOplate having a body with a first surface, a second surface opposed tothe first surface, the body having a proximal region and a distalregion, a first plurality of apertures passing through the plate, thefirst plurality of apertures accommodating a plurality of fixationdevices, a second plurality of apertures passing through the plate, thesecond plurality of apertures accommodating a plurality of flexiblestrands attached to soft tissue to be reattached to the bone; (ii)securing the TPLO plate to tibia by inserting the plurality of fixationdevices at various angles relative to a transversal axis of the body;(iii) passing at least one flexible strand (for example, monofilamentsuture) through at least one of the second plurality of apertures; and(iv) securing the at least one flexible strand to femur or to softtissue with a fixation point on the femur, to improve the rotationstability of canine bone or joint.

FIGS. 1-3 illustrate exemplary steps of a TPLO procedure with TPLO plate100 of the present invention for repair of bone segments of tibia 50 (ata tibia-femur joint region in the leg of an exemplary canine).

FIG. 1: Use a current C-guide 60 or similar instrument to allow drivingsuture passing pin 66 (FIG. 3) through plate holes to desired tibialtunnel entrance.

FIG. 2: The TPLO plate 100 has two or three exemplary suture holes/slots99 at a location where they would work. Could also have just one orbutton recess, depending on the characteristics of the particularrepair.

FIG. 3: Prepare biceps tendon 80 for transposition for bio-extracap;pull end of suture 70 (one at a time through, to tie over the TPLO plate100). Could also repeat procedure with fabellar suture, anchor, orsuture loop/fixation device (for example, a TightRope® device), asdetailed below. This procedure would also eliminate the need to extendthe incision or struggle to reach to the lateral femoral area.

FIGS. 4-9 illustrate various views of the shape and position holes of aprior art plate 1 and of an exemplary TPLO plate 100′ of the presentinvention.

FIG. 5: plate 1 is tilted to position; proximal screws are located inthe middle of the fragment.

FIG. 6: plate 1 is straight but the screws are too close with theosteotomy cranially.

FIG. 7: illustrates exemplary TPLO plate 100′ of the present inventionsuperimposed with plate 1 of the prior art.

FIG. 8: illustrates TPLO plate 100′ of FIG. 7 with an exemplary eyelet99 a located at a first position on the proximal region of the body ofthe plate (Option 1).

FIG. 9: illustrates TPLO plate 100′ of FIG. 7 with another exemplaryeyelet 99 b located at a second position on the proximal region of thebody of the plate (Option 2).

FIGS. 10(a)-(d) illustrate various views of an exemplary 2.7 mm standardTPLO plate 100 a of the present invention. FIGS. 11(a)-(d) illustratevarious views of an exemplary 3.5 mm small TPLO plate 100 b of thepresent invention. FIGS. 12(a)-(d) illustrate various views of anexemplary 3.5 mm standard TPLO plate 100 c of the present invention.FIGS. 13(a)-(d) illustrate various views of an exemplary 3.5 mm broadTPLO plate 100 d of the present invention. FIGS. 14(a)-(d) illustratevarious views of an exemplary 4.5 mm standard TPLO plate 100 e of thepresent invention.

Reference is now made to FIGS. 15-32 which illustrate subsequent stepsof a method of TPLO bone plate fixation according to an embodiment ofthe present invention and employing an exemplary TPLO plate 100, 100 a,100 b, 100 c, 100 d, 100 e, 100′ of the present invention.

The method begins by fixating exemplary TPLO plate 100 a by employingknown fixation steps in the art and as listed below:

Create and pin the osteotomy 55 at the level of tibia 50 (FIG. 15);

Check the TPLO plate 100 a first;

Position TPLO plate 100 a using K-wires 56 (for example, 0.062″ K-wires56) (FIG. 16);

Fixate TPLO plate using a fixation instrument (for example, a push-pulldevice, or a clamp/plier type device to fixate the plate);

Drill in loaded position of compression slot (for example, proximalcompression slot);

Check screw depth;

Insert non-locking screw partially;

Drill proximal holes 15 and insert screws 25 (FIG. 17);

Remove proximal positioning K-wire 56 (FIG. 18);

Remove osteotomy K-wire;

Drill and insert final proximal screw 25 (FIG. 19);

Remove distal K-wire;

Fully insert compression screw;

Drill and insert distal locking screw 25 (FIG. 20);

Remove fixation instrument (for example, push-pull device, orclamp/plier type device);

Drill and insert screw in compression slot (for example, distalcompression slot) (FIG. 21).

FIG. 22: align C-Ring Guide 60 with suture hole 99 and drill K-wire;

FIGS. 23(a) and 23(b): use 2.7 mm drill 65 over the K-wire;

FIG. 24: feed suture passer 67 through the tunnel;

FIG. 25: pass a flexible strand 70 for example, #5 FiberWire® suture 70,through the suture hole 99;

FIG. 26: pass tails of the #5 FiberWire® 70 through the nitinol loop 67;

FIG. 27: pass suture 70 through the tunnel;

FIGS. 28(a)-(c): fixate the suture 70—first method: use a knotlessfixation device 88 such as SwiveLock® 88;

FIGS. 29(a) and 29(b): fixate the suture 70—second method: tie suture 70around fabella 51;

FIGS. 30(a) and 30(b): fixate the suture 70—third method: use a button89 on the medial side of femur 53 and attach suture 70 to the button 89;

FIGS. 31(a)-(d): fixate the suture 70—fourth method: use suture holes 99for fixation of tendons, for example, biceps 80.

FIG. 32 illustrates a final exemplary TPLO repair 200 of the presentinvention with exemplary TPLO plate 100 a.

The at least one flexible strand 70 may be suture or a high-strengthsuture, such as FiberWire® suture, which is disclosed and claimed inU.S. Pat. No. 6,716,234, the entire disclosure of which is incorporatedby reference in its entirety herein. FiberWire® suture is formed of anadvanced, high-strength fiber material, namely ultrahigh molecularweight polyethylene (UHMWPE), sold under the tradenames Spectra(Honeywell) and Dyneema (DSM), braided with at least one other fiber,natural or synthetic, to form lengths of suture material. The at leastone flexible strand 70 may be also suture tape such as FiberTape®,suture chain such as FiberChain®, or a flexible material that is part ofa continuous loop/button construct provided with a button and acontinuous loop attached to the button. The flexible strand 70 may bealso a monofilament, as this works well in veterinarian applications.

In another exemplary embodiment, the flexible strand 70 may be acontinuous loop formed of a plurality of suture strands configured toseparate from a single strand to a plurality of strands in a continuousloop. In yet another embodiment, the flexible strand is an adjustableloop (forming a TightRope® ACL construct) which consists of twointerconnected, adjustable flexible loops formed by splicing a suturestrand in a manner disclosed in U.S. Pat. No. 8,460,379 issued on Jun.11, 2013 and U.S. Pat. No. 8,439,976 issued on May 14, 2013, thedisclosures of both of which are incorporated by reference herein intheir entireties.

The flexible strand 70 may be also part of a suture loop/needleconstruct similar to the FiberLoop® construct detailed and disclosed inU.S. Pat. No. 8,298,284 issued on Oct. 30, 2012, the disclosure of whichis incorporated by reference herein in its entirety. The flexible strandmay be suture tape such as FiberTape® (as disclosed in U.S. Pat. No.7,892,256) or collagen tape, or combinations thereof.

The fixation devices/implants 25, 88 may have various sizes (variousdiameters and/or lengths) and may be formed of biocompatible materialssuch as PEEK, biocomposite materials, metals and/or metal alloys, orcombination of such materials, among others. The fixationdevices/implants 25, 88 may be also formed of any rigid medicallyapproved materials, for example, plastic or carbon fiber, or combinationof different materials.

While the present invention is described herein with reference toillustrative embodiments for particular applications, it should beunderstood that the invention is not limited thereto. Those havingordinary skill in the art and access to the teachings provided hereinwill recognize additional modifications, applications, embodiments andsubstitution of equivalents all fall within the scope of the invention.

What is claimed is:
 1. A method of stabilizing a canine proximal tibia,the method comprising: performing an osteotomy on the canine proximaltibia; positioning a tibial plateau leveling osteotomy (TPLO) platerelative to the canine proximal tibia, wherein the TPLO plate includes abody that includes a proximal region, a distal region, a first surface,and a bone contacting surface opposite the first surface; securing theTPLO plate to the canine proximal tibia with a plurality of fixationdevices that are inserted through a first plurality of apertures formedthrough the body; passing a flexible strand through a second type ofaperture formed through the body; and securing the flexible strand to acanine femur to rotationally stabilize the canine proximal tibia,wherein a knotless suture anchor is utilized to secure the flexiblestrand to the canine femur, wherein a longitudinal axis of the bodybisects a majority of a length of the distal region and intersectsthrough a first portion of the proximal region, and further wherein thelongitudinal axis intersects a first aperture of the first plurality ofapertures, wherein a second axis intersects each of a second apertureand a third aperture of the first plurality of apertures, and furtherwherein the second aperture is formed adjacent to a first curved peak ofthe proximal region and the third aperture is formed adjacent to asecond curved peak of the proximal region, wherein the second axis iscloser to parallel than perpendicular relative to the longitudinal axis.2. The method as recited in claim 1, wherein securing the flexiblestrand to the canine femur includes knotlessly securing the flexiblestrand to the canine femur with the knotless suture anchor.
 3. Themethod as recited in claim 1, wherein securing the flexible strandincludes tying the flexible strand to a canine fabella.
 4. The method asrecited in claim 1, comprising, prior to passing the flexible strandthrough one of the second type of aperture, preparing a tunnel throughthe bone.
 5. The method as recited in claim 4, comprising: positioning asuture passer through the tunnel prior to passing the flexible strandthrough the second type of aperture; connecting the flexible strand to aportion of the suture passer after passing the flexible strand throughthe second type of aperture; and feeding the flexible strand through thetunnel with the suture passer.
 6. The method as recited in claim 4,wherein preparing the tunnel includes drilling the tunnel through thebone.
 7. The method as recited in claim 1, wherein a first portion of alength of the body is established by the distal region and a secondportion of the length of the body is established by the proximal region,and further wherein the first portion of the length is larger than thesecond portion of the length.
 8. The method as recited in claim 1,wherein the second axis extends at an acute angle relative to thelongitudinal axis.
 9. The method as recited in claim 1, wherein thefirst aperture, the second aperture, and the third aperture aresubstantially equally sized apertures.
 10. The method as recited inclaim 1, wherein the first aperture is formed adjacent to a third curvedpeak of the proximal region.
 11. The method as recited in claim 1,wherein the second type of aperture is disposed in the proximal regionof the body.
 12. The method as recited in claim 1, wherein passing theflexible strand through the second type of aperture includes passing asingle flexible strand through the second type of aperture.
 13. Asurgical method comprising: positioning a tibial plateau levelingosteotomy (TPLO) plate relative to a canine proximal tibia; and securingthe TPLO plate to the canine proximal tibia with a fixation device,wherein the TPLO plate includes a body comprised of a proximal region, adistal region, a first surface, and a bone contacting surface oppositethe first surface, wherein a longitudinal axis of the body extends alonga length of the distal region and intersects through a first portion ofthe proximal region, wherein the longitudinal axis intersects a firstaperture of a first plurality of apertures formed through the proximalregion, wherein a second axis intersects each of a second aperture and athird aperture of the first plurality of apertures, wherein the secondaperture is formed adjacent to a first curved peak of the proximalregion and the third aperture is formed adjacent to a second curved peakof the proximal region, wherein the second axis is closer to parallelthan perpendicular relative to the longitudinal axis, wherein theproximal region is angled relative to the distal region such that theproximal region is offset from either a left-hand side edge or aright-hand side edge of the distal region, and further wherein, for aright-hand side offset, both a left-hand side edge and a right-hand sideedge of the proximal region are shifted to the right of the left-handside edge of the distal region.
 14. The surgical method as recited inclaim 13, wherein the second axis extends at an acute angle relative tothe longitudinal axis.
 15. A surgical method comprising: positioning atibial plateau leveling osteotomy (TPLO) plate relative to a canineproximal tibia; and securing the TPLO plate to the canine proximal tibiawith a fixation device, wherein the TPLO plate includes a body comprisedof a proximal region, a distal region, a first surface, and a bonecontacting surface opposite the first surface, wherein a longitudinalaxis of the body extends along a length of the distal region andintersects through a first portion of the proximal region, wherein thelongitudinal axis intersects a first aperture of a first plurality ofapertures formed through the proximal region, wherein a second axisintersects each of a second aperture and a third aperture of the firstplurality of apertures, wherein the second aperture is formed adjacentto a first curved peak of the proximal region and the third aperture isformed adjacent to a second curved peak of the proximal region, whereinthe second axis is closer to parallel than perpendicular relative to thelongitudinal axis, wherein the proximal region is angled relative to thedistal region such that the proximal region is offset from either aleft-hand side edge or a right-hand side edge of the distal region, andfurther wherein, for a left-hand side offset, both a left-hand side edgeand a right-hand side edge of the proximal region are shifted to theleft of the right-hand side edge of the distal region.